Fetoscopic Laser Coagulation of the Vascular Equator Versus Selective Coagulation for Twin-to-Twin Transfusion Syndrome: An Open-Label Randomized Controlled Trial

摘要

Monochorionic twin pregnancies have a perinatal mortality rate of 11%. The complication of twin-to-twin transfusion syndrome (TTTS) is preferably treated with fetoscopic laser coagulation of the vascular anastomoses, although intertwin vascular connections can remain patent and cause severe complications. This open-label, multicenter, randomized controlled trial was performed to compare the efficacy and safety of the newly developed Solomon technique and standard laser coagulation.Parturients with monochorionic, diamniotic twin pregnancies of 26 weeks' gestation or less complicated by TTTS were randomly assigned to undergo either the Solomon technique or standard laser coagulation. A cannula was introduced transabdominally into the amniotic cavity of the recipient twin. After the vascular anastomoses were identified, all visible anastomoses were coagulated. For the Solomon technique, after coagulation of all visible anastomoses, a thin line of tissue at the placental surface was coagulated from 1 edge of the placenta to the other, to connect white areas that resulted from coagulation of the anastomoses. This was done to completely separate the 2 parts of the chorionic surface of the placenta at the level of the vascular equator. Both groups received identical postoperative monitoring and peripartum management. Available placentas were examined for the presence of residual anastomoses by color dye injection within 1 week. The primary outcome was a composite of the incidence of twin anemia polycythemia sequence, recurrence of TTTS, perinatal mortality, or severe neonatal morbidity. Secondary outcomes were residual anastomoses, gestational age at birth, birth weight, and complications.